Chapter 44: Hematopoiesis and Immunomodulation

Question 1

Hb levels should be between _____ g/dL

Answer 1

10-12

Question 2

What drug can be used to treat cancer associated anemia, anemia of chronic kidney disease, or chemotherapy induced anemia, and can be abused by athletes?

Answer 2

Erythropoietin

Question 3

Serious adverse effect of erythropoeitin?

Answer 3

Hypertension

Question 4

Erythropoeitin is NOT indicated for what type of patients?

Answer 4

Patients receiving myelosuppresion chemo intended for cure

Question 5

Drug that interferes with normal DNA synthesis and may pose a long term cancer risk? Used to treat myelodysplastic syndrome.

Answer 5

Decitabine

Question 6

What are the clinical applications of hydroxyurea?

Answer 6

Sickle cell anemia
Refractory CML
Head/neck cancer
Malignant melanoma
Ovarian carcinoma

Question 7

MOA of hydroxyurea?

Answer 7

Inhibition of ribonucleotide reductase - Cancer Treatment

Increase HbF

Question 8

Is hydroxyurea safe for long term administration?

Answer 8

Yes, even in children

Question 9

rhG-CSF drug - what is it and what does it do?

Answer 9

Filgrastim - raise neutrophil levels

Question 10

Filgrastim and PEG Filgrastim are used treat ____?

Answer 10

Neutropenia

Peripheral blood stem cell harvest

Question 11

Major common adverse effect of Filgrastim?

Answer 11

BONE PAIN! - resolves with discont’ use

ARDS, flu like illness, nausea, vomiting

Question 12

Which has a LONGER half life, filgrastim or PEG filgrastim?

Answer 12

PEG

Question 13

Sargramostim MOA?

Answer 13

rhGM-CSF - multi lineage

Increases myelopoiesis - neutrophils and eosinophils

Question 14

Which drugs can cause worsening thrombocyopenia after cessation of these drugs?

Answer 14

Eltrombopag

Romiplostim

Question 15

Eltrombopag MOA?

Answer 15

small molecule TPO receptor agonist

Oral

Question 16

Romiplostim MOA?

Answer 16

recombinant IgG Fc peptide fusion protein –> binds to and activates TPO receptor

Question 17

TPO receptor agonists….how must you administer these?

Answer 17

Prophylactically because there is a 1-2 week delay

Question 18

What do you use the TPO receptor agonists for?

Answer 18

Eltrombopag and romiplostim

ITP that is unresponsive to steroids, splenectomy, immunoglobulins

Question 19

What are the agents that stimulate platelet production?

Answer 19

Eltrombopag
Romiplastim
Oprelvekin

Question 20

What drug is produced in e.coli and used to stimulate platelet production? How?

Answer 20

oprelvekin

dose dep. increase in platelet and megakaryocyte in BM

Question 21

What is the only drug approved for prevention of severe chemotherapy-induced thromobcytopenia?

Answer 21

oprelvekin

Question 22

What are the major adverse effects of oprelvekin (rhIL-11)?

Answer 22

fluid retention, atrial fibrillation, cadidiasis, fatigue

Question 23

Levasimole MOA?

Answer 23

causes macrophages and T cells to secrete cytokines (like IL-1) ….suppress tumor growth

Question 24

Levasimole clinical app?

Answer 24

colon cancer - in combination with 5-FU!!!!!!

Question 25

IL-2 clinical app? What does it do? Why might it not be used?

Answer 25

melanoma tx increase t cell production low efficacy and high toxicity @ therapeutic doses

Question 26

Tretinoin clinical app?

Answer 26

acute promyelocytic leukemia (AML) acne vulgaris!!!!!!!! fine wrinkles of the face

Question 27

What is tretinoin?

Answer 27

ATRA! all trans retinoic acid

Question 28

What is the major adverse effect of ATRA?

Answer 28

``` ATRA Syndrome: fever ARDS w pulmonary infiltrate edema and weight gain multisystem organ failure ``` Leukocytosis Skin dryness